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Monday, November 29, 2010

Where Does Obligation End? Part 1

Recently we had a client visit one of our clinics (we're a multi-location practice) because she believed her dog had eaten some rat poison. The doctor worked up a treatment plan and it was presented to the owner. She said that she could not pay for the services. She was offered Care Credit (a medical credit card here in the US), but said she wouldn't qualify. She didn't have any other credit cards, and said that her check would bounce. Basically she was offered every payment option we have (we don't do in-house billing and payment plans), but couldn't do any of them. So treatment was not performed and she was referred to a local emergency clinic in hopes that they might be able to work out payment with her. Her visit there ended up the same way, with her being unable to make any payment and the emergency clinic declining to treat without being paid.

Almost two weeks later I saw her dog for acute vomiting. The dog was acting fine with no signs of having had any bleeding problems (the main complication of most rat poisons). She was on a health care plan with us that allowed some blood testing at no additional cost (it doesn't cover treatments, just basic preventative care), so we ran these and everything came back normal. Since the owner couldn't afford any other diagnostics I put the dog on some antinausea drugs and sent her home for observation. What else could we do?

During all of this mess the client has been belligerent and confrontational. She has accused us and the emergency clinic of "neglect and abuse" for "refusing to treat" her dog. She has made statements that we are "killing her dog", that we "don't care about animals", and everyone is "just about the g**d*** money." She is threatening legal action if her dog dies (it's been close to four weeks now, so the chances of that happening are slim) and has called us repeatedly with complaints and abusive language. In her opinion we should have treated her dog regardless of her financial situation.

Personally I'm not worried in the least about this client, as I know that we and the emergency clinic offered every appropriate action and treatment. We have documented all conversations and declined services, so she has absolutely no legal ground for a suit. However, it does bring up an interesting question that I'm putting to a poll. Does a veterinarian (or by extension, any doctor) have an obligation to treat a patient regardless of the ability to pay? Every veterinarian sees pets who don't get needed treatment because the owner can't afford it. In many cases these pets end up suffering or have chronic problems, despite the fact that have the ability to treat them. According to this owner's comments, we should be treating them anyway.

So let's see what the poll says and then we'll revisit this topic in a little over a month.

23 comments:

I would start selling things to be able to afford vet care for my cats. I have accumulated probably almost $2000 in bills this year from adopting 3 cats (2 from a shelter and 1 from a rescue (hoarding/living in filth,owner living in condemed building). One cat from the shelter, I sadly had to put to sleep after spending $1000 on him. He was 14. Luckily, my vet sees the compassion and dedication I have to help animals. She has not charged for certain services at times. Once I thought I was going to have a very high bill from the rescue cat (fleas, worms,mats,shots, Fiv, FeLv, tests, dx with bartonella) and I thought I might have I problem making payment. I have always paid my bills in full. She said I could make payments. When I got the bill, it was much lower than I expected as she did not charge me for anything but blood work, labs, and tests. I almost cried. I was able to pay the bill in the full. I would never expect a vet I did not have a relationship with to agree to do a payment plan with me. I had a flawless payment record with them. I never asked for free services. My vet also does not accept Care Credit, so this may make a difference. I do have a Care Credit account open in case my cat needs to go to the emergency vet or see a specialist. The answer is no the vet does not have an obligation to treat the pet when the owner does not have the funds to pay. Also with the owner being verbally abusive to you and your staff, I would possibly refer her to another vet. No one deserves to be treated like that.

This was a very hard question for me to answer.I am very lucky to have a vet that lets me make payments and yes I have sold things to pay a vet bill.I would have a hard time saying no, but I understand that you would go out of business and not be able to help anyone.I think it is up to each doctor and clinic. The lady had no right to get angry at you! You have a very hard and wonderful job. Hugs to you .Bcat

I put money aside from each paycheck specifically for my pet expenses. That has allowed me to build a financial cushionallowing me to pay those unexpected medical bills and save for the months when I know I'm going to have higher expenses (buying 6 months worth of flea and/or heartworm preventive). I guess I figure they are MY pets, therefore my obligation. I know there are others who have pets but don't have the means or fiscal discipline that I do and I struggle with whether I would wish to deny those folks their pets - but a pet is an obligation of time AND money. I can't imagine the heartache experienced by vets who end up watching their patients suffer because the shortcomings of the patient owners.

I was very fortunate not too long ago to have a vet that I have been using for almost 15 years. Last month I had an emergency when my shepherd bit the nose of my puppy. I thought a stitch or two would maybe be $100. Imagine my surprise when the estimate came back at over $400. There was no way I could pay that much at that moment, so I inquired about splitting it up over the month.

My doctor was kind enough to do that and I was lucky to have established a relationship where I could ask that of him.

On the other hand, had I taken Rudy to any other vet, or the emergency hospital, I wouldn't have felt comfortable asking. Did Dr. Riggs have a right to turn down my request - yes, he did. Would I have had a right to be angry? No, not at all...I knew the policy when I walked in with Rudy.

I could go on and on, you're not a non-profit practice, and should not be expected to be.

Money is always such a tough issue in vet med. I don't understand why people think that because it's to do with health that a clinic shouldn't charge or whatever. It's a business just like any other, and we should have to pay for services rendered. Just as we would at a doctor's office or hospital.

I don't have a lot of extra money for vet bills. I can't go over the top with the care I choose for my pets. If it came to having to do a $2000 surgery for a pet, I probably couldn't do it... not that I wouldn't want to, but I'd probably have to choose palliative care and see what happened.

I would never expect my vet to give me a break or something for free though, no matter what my circumstance.

His Name Was Henry:Stark County Vet Emergeny Clinic...Notice how it says EMERGENCY in the name. I had a very sick puppy who was throwing up blood. They refused to see him without payment up front. They accept paper checks to hold for two weeks but refused to hold my check card info in the same way. I had to sit in my car with my puppy throwing up BLOOD for two hours as I tried to find someone who could give them their credit card information over the phone. Over $70 to just walk in the door, another $70 for a test and $75 to hold him as they put him to sleep BECAUSE I couldn't give them $1500 in FULL at midnight to try and save his life. Oh yeah their business cards say they love pets. It should say they love money. I"ve never experienced so much greed in my life. All because they would only hold a paper check and not a check card info..if you aren't rich and its after hours in Stark county our animals are going to die. He was only 7 weeks old hadn't even had a chance to live yet.

P.S. To kill him cost 50.00 but I had to pay an extra 25 in order to hold him as they finished him off because they had to put a IV line in so they wouldn't "accidently stick me with the needle". I've been in rescue years and never has my regular vet ever stuck me with a needle or needed a IV line.

I think it should be REQUIRED that emergency vets accept ALL forms of payment. I am telling my story everywhere until change is made.

Ruthie, I'm sorry you had a bad experience and lost your pet. But any business has a right to expect payment for services rendered. There are also safety risks for you as well as legal liability for the clinic to hold a debit or credit card number, especially with identity theft so commmon. Asking to be paid for services performed is NOT greed.

Even in human hospitals payment must be given to the doctors and staff. If the patient can't pay, then that money comes from insurance companies, taxpayers, and similar sources, but I can assure you that the bill generally does get paid. In veterinary medicine we don't have insurance companies that will increase rates to cover those who can't pay (which is one of the reasons why insurance costs are high in humans), and we don't have taxes subsidising the emergency clinics like is common in many human hospitals.

If a business can't get paid, they can't stay in business. And if the emergency clinic goes out of business, who will help the pets?

Okay, so in that case who pays for those who cannot afford treatment? Please tell me a sustainable business model that will allow a veterinary practice (emergency or otherwise) to stay in business by giving expensive services away to some people, and how you would determine which people would get the free services. This proposed model also should NOT include charging higher prices to the so-called "rich" (how do you define that, anyway?) to cover the costs of others.

1st..how about what they charge at emergency clincs...seventy five dollars to put a puppy to sleep...fifty if you don't hold the puppy while he dies..extra money because they "need to put an IV in so they don't accidently stick the owner"..that is total BS!!! My vet has never had such a charge and never has stuck a person.

Allow all forms of payment...allow me the risk of leaving my bank card info if I want to take that risk.

Allow a minimum of life saving care on short term credit..don't assume we are all jerks and don't pay our bills.

We have a free clinic for people..there needs to be one for pets that charge a sliding scale for treatment based on income..if I show my food stamp card I only have to pay ten dollar office call instead of 78 dollars to just walk in the door...do fundraisers throughout the year to supplement costs.

I love my personal vet..I've had to make payments sometimes and NEVER have she not been paid in a timely manner.

Emergency vets where I went are greedy evil people to know a seven week old puppy was vomiting blood in my car and refused to take a payment method that would have insured they'd get their money. I'm on mission to get that changed there. We should be allowed to do what we have to do to get our pet card for...accepting a blank check but not card...same risk..they could wipe out my account anytime.

Ruthie, you have no concept about what kind of money it takes to run an emergency clinic (or any veterinary clinic). And just because your vet has never stuck someone doesn't mean that other vets haven't (I've know it to happen). In today's litiginous society they have to protect themselves, because I can promise you that if they accidentally poked someone they could be and would likely be sued. Seventy-five dollars to euthanize a pet is actually a very reasonable cost across veterinarians (whether or not your own vet charges this). And no, it's not the same risk if you have the check versus the card.

Just because you are willing to take the risk doesn't mean that the business is willing to take the liability. Even if you gave permission to hold it, if someone stole that number and used it inappropriately, they are still liable for any damages, regardless of what you told them you would allow.

Allowing short-term credit? Great in principle, but you have absolutely no idea how many times this blows up in a business's face. It's happened to me numerous times. Sure, I've had clients pay the bills when I've extended credit, but it's extremely common for it to happen the other way. There are other forms of credit, such as credit cards and Care Credit, so a veterinary practice doesn't need to take the risk on themselves. You may eventually pay, Ruthie, but many people won't and there is no way for someone to tell ahead of time who is a deadbeat and who isn't.

The "free clinic" for people isn't free to operate. It's supported by donations and taxes. I can promise you that the "free clinic" still has to pay their doctors, their staff, their suppliers, their utilities, and so on. Where does the money come from if the client/patient aren't paying? Where do you propose a "free veterinarian" gets their funds from?

Your personal vet knows you, Ruthie. They have established a relationship with you and know that over time you will pay your bills. They would be very unlikely to do this if you were visiting for the first time and had a very high bill.

I sincerely doubt that the vets at this clinic could really be classified as "evil". Again, they have bills to pay, and if they don't get money for services, they will close and lose their jobs. Expecting to be paid for doing a professional service is not "greedy" or "evil".

It is EVIL and GREEDY to not help a puppy throwing up blood in your parking lot There is no other word to describe it. The laws need to change my local hospital if you went in vomiting blood and no money they'd have to extend basic care...that needs to go for vets too..afterall you claim the term Doctor..."the prevention and relief of animal suffering" I just don't know how they live with themselves. You are one of them so you aren't going to see the greed or evil in all of this you like having money...if you were in my shoes...I rescue and survive on donations...I would have been able to get the money from another rescue the next day..but not at 1am...they wanted the money NOW. If you want money to come first they shouldn't try to claim "we love pets" it should read "we love money". Who in any given emergency can get access to that kind of money in the middle of the night? I can't get credit cards but I could have gotten the money. Henry died due to money.But hey Karma is a bigger bitch then they are...there is comfort in that knowledge. In the meantime I'm not going to stop until they make it more reasonable for EVERYONE an opportunity to save their pets life! I got help from a friend who happened to be awake and as well as giving them the rest of my disability income for the month. Not sure how I'll get food this month but I couldn't let him suffer another minute. Keep defending your kind..your argument just makes it sound like I said, Rich people's pets will live and as usual the poor people's beloved pets die.

I'm on a mission...keep chatting away about how expensive it is and get into your nice car outside your nice home with a full refridgrator..I've seen how vets live...you aren't hurting for money...so you have a pretty high profit margin. And probably treat collegues for free even though they could afford it the most. Professional courtesy..seen it the hosptial and Dr's office I use to work.

Ruthie, you must know different vets than I do because vets are NOT rich. We make about 1/3 of what a human doctor makes. I drive a 1995 Chevy Lumina because I can't afford a newer car and I live in a 1300 square foot house. I most certainly don't have a "nice car" or a "nice house" like you're implying. And truthfully that's the rule among my colleagues.

You obviously are very clueless about how a veterinary practice is run because we do NOT have high profit margins. Most vets struggle to stay in business in economies like this, and many vets go out of business because they fail to manage expenses and profits acceptably.

Again, hospitals and human doctors STILL GET PAID for their services even if the patient can't pay. That's because they charge HIGHER rates for those who CAN pay, and also often get supplement from taxes to cover shortfalls (not all, but some do). Veterinarians don't have those luxuries. We cannot subsidize low-income people by charging more for other clients.

Despite your claims, you have no clue at all how a veterinary practice is managed and what the reality of veterinary finances are. No vet could stay open by practicing how you are suggesting. It simply doesn't happen, and those who do go out of business.

I'm sorry that you're so filled with hate and bitterness and I wish you the best in your life.

Yes I am full of hate because the vet let money come before the life of a helpless puppy. They would have gotten their money if it would have been when services were RENDERED and NOT BEFORE. It would have been the next day when I could have gotten the money!

Chris: I love you! Ruthie: Come on get a grip and wake up!! There are such an extreme amount of overhead costs in a vet clinic, and that doubles in an ER vet clinic! My bet is that your puppy had Parvo (am I right?) and you said you've "rescued" for years? well if you've truly "rescued" for years then you would know the costs...this would not be your first visit to an ER clinic. NO ER clinic is going to have payment options other than care credit; holding a check alone is a legal risk and more than a lot of clinics that don't have an established clientele. Holding check card information is just simply not an option....it's ILLEGAL and just because you say the money will be there doesn't mean anything.....say they kept your information and a week later they run it (b/c u said they could) and it's declined!! Then where are they? But if they have a check then they can take legal action when it bounces! As far as when services rendered: (it mean's when the services are done!) Which means that as soon as they placed an IV and attached your puppy to fluids that is the rendering of services!I think it's great that you want to change things.....however, you don't have any reasonable suggestions! You're asking these people to risk their lively-hood (which is NOT a lot of money) by taking your "word-for-it" that you will pay! Do you have any idea how many people they likely have that they have tried to help/believe?! It's the people that you can't trust that wind up "ruining" it for everyone.You seriously need to get a grip on reality! If you cannot afford the care to provide a beloved pet, well then you shouldn't have one! I'm sorry; but it's true! it's not fair to an animal that has to die b/c it's owner is too irresponsible to save some money out of every pay b/c they want to have a cigarette or beer!If your going to "try to change things"...then have a reasonable option to present!! Any facility is going to be open to more payment options to help people! Any vet is a vet b/c they truly want to help animals! NOT for the $$$!!!! If they wanted a lot of money, then they wouldn't have went to school for 8 years (the same as an MD[human Dr.]) and paid the same amount of money for the school as an MD... to graduate and make far less than an MD (1/3 of the money to be exact!) A doctor that was in it for the $ would've got to Medical School NOT Veterinary School!

Oh P.S: please Do Not say you're on a fixed income either! Because i'd like to know one person that is NOT on a fixed income! Even the President of the US is on a fixed income! It's simply what you do with the money and how you budget it!

Jean I don't believe for a second you ever worked for a vet. If you did you would know that most rescues don't have an account to draw from, and that most vets extend us credit. Come back to the real world please and stay away from animals!

I'm making a difference, I've actually DONE things instead of running my mouth like you. Things are changing in my area because I didn't just sit here and act like a know it all bitch like yourself.

If nothing else stay away from animals you haven't got a clue and could cause more harm. Therapy for your psychotic temper might be a good thing for those people who must be around you.

Ruthie: News flash: If anyone has Psychotic tendencies its YOU!Am I a know it all? No, I just am educated. And yes i have worked for several vets and I love my job and animals, and truly feel sorry for people that don't know any better and for their pets.I don't have any affiliation with the facility in which you are talking about; I don't even live in/near Ohio...that's something you made up in your head.True Rescues have some money from government grants and yes vets extend credit to the ones that they are affiliated with and/or have established a relationship with them!Like I said: i'm glad that you are trying to change things; because we would all like to help more but you have to have something more than...."they have to keep your check card information." I mean common petition the government or something....you'll certainly help more people and pets in the long run! and you thinking that you know all about me is very entertaining to me! You have NO idea what I do and what I am doing! I have a Fund that I have established to try to assist people who's pets have been injured in things that could not be prevented!! So do everyone a favor and do something real about it other than blogging!~Jean

Wow, I am soooo glad that you are not my vet. I get running a business, but jesus, man, have a little bit set aside for these cases and then keep the dog in a kennel until they pay - but SAVE THE ANIMAL'S LIFE!

Once you start treating life with dollar signs maybe it's time to find a new profession!

There are ways to make that work and not just make it so that the PET who had NO CHOICE to get that irresponsible owner has to DIE!

Amy, I can promise you that your vet DOES have to face decisions like this. There are no vets in business that can afford to give away their services, and every vet has to face decisions where they decide not to treat a pet because the owner cannot afford it. You're just not aware of these times as a client. Look at the comments and talk to professionals in the field, and you'll see that the people who actually work in the field know about these problems.

Again, Amy, I can guarantee that your vet has declined treating a pet because the owner couldn't pay for the treatment. It happens all of the time, and is a reality of veterinary practice. Vets who treat pets without worrying about getting paid quickly go out of business.

It's also not as simple as keeping the pet until the owner can afford treatment. What if the cost runs into the hundreds of dollars? Let's take $500 as a nice round figure. What if the owner can only afford $100 per month? Are you suggesting that the vet keep the dog for 5 months?

And many vets do have a fund set aside for charity cases (including my own practice), but you'd be amazed at how quickly that money gets used up and how tough it can be to build it back up.

As I've mentioned before, I'd love suggestions as to how this can work out. Amy, you seem to know of many ways to handle a situation like this and I'm very open to suggestions.

Ruthie has a right to be angry when talking about a life or death situation and the suffering of an animal (supposedly of paramount importance to a vet). If that vet is more worried about payment than treatment, it is clear where his priorities lie.

Another thing, liability or not, charging $25 to insert an IV line is ridiculous- the catheter is pennies and the procedure done in seconds by a nurse. They should have done it for free, especially in this situation- not profiting from someone's loss. It's emotional blackmail.

When my cat was put down, the vet was so mutually heart-broken that she did it for free, even sending a sympathy card out. Her business is doing great and hasn't been crippled by her generosity.

I've had mixed results with vets, from condescending pseudo advice ultimately aimed at lining their pockets, to being told that trimming my cat's claws meant it would be eaten by a dog. I've even been told I could abort my cat's kittens which sickens me (we do not have an over-population problem like the US). I've even been told by a vet that they guarantee that unless I neuter my cat, he would be hit by a car. Ironically, a few months after he was neutered, he was hit by a car.

I have had some good experiences too, but unfortunately the bad ones stick out. Vets are businesses that get paid to sell you things. They teach you that neutering your dog is good, when it actually enhances their risk of cancer (read the wiki page). They tell you to feed your pet Hills Science Plan (which they sell) despite pet-foods being responsible for most UTIs and health problems. They sell you vaccinations which could lead to on-site sarcomas and lie about the risks. The safety of your pet, ultimately, lies in your hands. Choose wisely!

I had a vet charge me £30 just to prescribe a shot of antibiotics and anti-inflammatories for my cat after she tore a claw out. Seeing as I couldn't afford it and knowing they would only glance at her quickly (which they did), I asked if they could waive this fee and I'd pay for the shots etc. instead. Not possible. Instead I paid £70 for minutes with a vet whilst they jabbed my cat with 2 shots then asked me to leave because they were busy (despite having paid for their time). They then had the cheek to tell me to bring her back tomorrow with another £70 for sedation and inspection of the claw. WTF! Sadly, my money tree was not in season and my bottomless pit had run dry, so I asked how necessary it was, only to be mocked as the vet said he would recommend it but didn't want to 'take food off our table'! Well, thank-fully he didn't as (despite being a layman, but with the benefit of having eyes) I managed to look at the claw myself and it was fine.

If there is a desperate situation, the vet should put the animal's health first and that SHOULD BE THEIR JOB. When you go into a line of work involving care, the primary responsibility should be the provision of that care. If someone is short on funds and desperate, a compromise should be made. Veterinary care should be a calling and not a money-spinner. Yes, make your money, you deserve it, BUT there is a line between plain ripping someone off and doing your job. Don't cross it. I think that is where people are divided.

Ruthie sounds like she has one of those "rescues" we see on the news. Hundreds of dogs living in filthy conditions, eating rotten food and their own waste, dead dogs left on the ground for days and weeks. Then the "owner" screams at the vets for "letting animals suffer and die."

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About Me

I have been interested in science and animals all of my life. When I was 9 years old I decided that I wanted to be a veterinarian. My first job was at a vet clinic in 1984, when I was fourteen. I made a few detours along the way, getting a Master's degree (MS) in 1991. However, in 1997 I did finally graduate from Vet School at NC State. I've been practicing since then, with another detour to teach college Biology. Besides all of that, I'm a born-again Christian, attend Renaissance Faires, and am a big geek who is into comic books, sci-fi, and fantasy. I've been a happily married man since 1998, and have two wonderful children.

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